MEDICAL ASSESSMENT FORM For Students with Permanent Disabilities - Nova Scotia

M2012

Instructions for Completing

MEDICAL ASSESSMENT FORM

For Students with Permanent Disabilities

Nova Scotia Student Assistance requires this form to be completed by a qualified medical assessor in order to verify

the applicant’s permanent disability and to determine eligibility for disability-related financial grants and disability training

related goods and services, while attending post-secondary education. Individuals who meet the disability criteria

become part of the Department of Advanced Education Labour Market Agreement for Persons with Disabilities

(LMAPD) program administered through the Post-Secondary Disability Services Division.

Complete the Consent Form on page 1, Section A and Section B on page 2.

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Have the sections relating to your disability completed by the appropriate qualified medical assessor. For

example, if you are visually impaired, your form should be completed by an Ophthalmologist or Optometrist. If

you have a hearing impairment, your form should be completed by an Audiologist. Your limitations and barriers

to your program of study must be clearly identified.

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If you have a Learning Disability, you must attach a current Psycho-Educational Assessment, completed

within the last 5 years by a Registered Psychologist and submit it with the signed Consent Form (page 1) and

completed Section A and B (page 2). Any other supporting documentation in reference to your learning needs

overcoming limitations/barriers. Any other supporting documentation in reference to your learning needs along

with copies of any previous Psycho-Educational Assessments would be beneficial.

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If you previously did not meet the disability criteria either because your documentation was not current or there

was insufficient information provided to support your application, you must provide additional or current

information from your medical assessor that clearly outlines the limitations and barriers that your disability will

present while participating in studies at a post-secondary institution. Any previous documentation sent to our

office is on file.

MEDICAL ASSESSOR

This Medical Assessment Form will be used as one of the criteria to determine this student’s eligibility to receive

Medical assessors must complete all parts of Section K on pages 6 and 7, clearly describing the disability-

related educational barriers and recommended interventions.

Completed Forms are to be mailed to: Nova Scotia Student Assistance

PO Box 2290, Halifax Central

Halifax, NS B3J 3C8

Telephone: 424-8420 Toll Free in Canada 1-800-565-8420

IMPORTANT INFORMATION

Your student loan application will not be processed until all documentation has been received.

All information must be received no later than two months before your period of study ends. Funds cannot be

released after your period of study end date.